Provider Demographics
NPI:1427770387
Name:RUNYON, KIMBERLY CHRISTINE (LPN)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:CHRISTINE
Last Name:RUNYON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:445 N DARLINGTON ST
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:IN
Mailing Address - Zip Code:46147-9067
Mailing Address - Country:US
Mailing Address - Phone:708-595-8622
Mailing Address - Fax:
Practice Address - Street 1:7133 MEADOW TRL
Practice Address - Street 2:
Practice Address - City:BROWNSBURG
Practice Address - State:IN
Practice Address - Zip Code:46112-1388
Practice Address - Country:US
Practice Address - Phone:708-595-8622
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-16
Last Update Date:2022-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN27076871A164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse